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Caesarean Section
Surgical delivery of the baby through an incision in the abdomen and uterus, performed as an elective procedure for planned clinical indications or as an emergency for acute fetal or maternal compromise.
Overview
Overview
Caesarean Section is a major abdominal surgical procedure performed to deliver the baby through a transverse incision in the abdomen and uterus when vaginal birth is either unsafe or not possible due to a maternal or fetal indication. It is performed under spinal anaesthesia in the vast majority of cases, allowing the mother to be fully awake and her birth partner to be present for the delivery. Caesarean section may be planned as an elective procedure well in advance or performed as an emergency at varying degrees of urgency from minutes to hours depending on the clinical situation. The operation takes approximately 45 to 60 minutes and full physical recovery requires approximately 6 weeks.
Types of Caesarean Section
- Elective caesarean section — planned operation performed from 39 weeks gestation for a documented clinical indication such as placenta praevia or confirmed breech
- Emergency Category 1 caesarean — immediate surgery for an immediate threat to maternal or fetal life requiring delivery within 30 minutes
- Emergency Category 2 caesarean — surgery for non-immediate maternal or fetal compromise requiring delivery within 75 minutes
- Emergency Category 3 caesarean — surgery where early delivery is needed but the clinical situation is not immediately compromising
- Classical caesarean section — vertical uterine incision used in specific situations such as extreme prematurity or inaccessible lower uterine segment
Risk Factors of Caesarean Section
- Placenta praevia — low-lying placenta partially or completely covering the internal cervical os preventing safe vaginal delivery
- Persistent breech presentation at term (baby presenting feet or buttocks first) where external cephalic version has failed or is contraindicated
- Previous classical (vertical) uterine incision carrying a significantly higher risk of uterine rupture in subsequent labour
- Active primary genital herpes simplex infection at the onset of labour where caesarean section significantly reduces neonatal HSV transmission risk
- Major feto-pelvic disproportion — estimated birth weight above 5kg combined with clinical concern about safe vaginal delivery
- Two or more previous caesarean sections where the cumulative uterine scar significantly increases placenta praevia and accreta risk
Symptoms of Caesarean Section
- Post-operative wound pain at the Pfannenstiel incision site managed effectively with regular paracetamol, ibuprofen, and short-term oral morphine
- Uterine cramping and afterpains as the uterus involutes to its pre-pregnancy size in the days to weeks following delivery
- Referred shoulder tip pain from residual carbon dioxide or blood irritating the diaphragm under the peritoneum
- Urinary discomfort and difficulty voiding normally when the urinary catheter is removed 12 to 24 hours post-operatively
- Wound infection presenting as increasing redness, swelling, wound discharge, and fever typically 5 to 7 days post-operatively
- Deep vein thrombosis presenting as unilateral calf pain, swelling, redness, and warmth in the first 2 to 6 weeks after surgery
- Prolonged lochia (post-partum vaginal bleeding and discharge) lasting up to 6 weeks which is normal after caesarean delivery
- Post-operative ileus causing abdominal bloating, distension, and delayed return of bowel function in the first 24 to 72 hours
Key Benefits
Discover the advantages of choosing our caesarean section services.
Spinal anaesthesia allows the mother to be fully awake and partner present for the birth
Prophylactic antibiotics reduce post-caesarean wound infection rates by 60 to 70%
Dissolvable subcuticular sutures avoid a separate suture removal appointment
Active management of the third stage reduces haemorrhage from uterine atony after caesarean
Enhanced recovery protocol enables mobilisation within 12 hours and discharge within 24 to 48 hours for elective caesareans
Clinical Features
The technology, techniques and clinical approach behind our caesarean section.
Prophylactic antibiotic administered at skin incision for all caesarean sections
Oxytocin infusion started immediately after placental delivery minimising blood loss
Left lateral tilt on operating table prevents aortocaval compression
Immediate skin-to-skin contact after birth promoted even during uterine closure if clinically stable
DVT prophylaxis with LMWH prescribed from 6 hours post-operatively for all caesarean patients
Preparation Instructions
Fast from midnight before an elective caesarean or as specifically instructed. Take your prescribed antacid medication the morning of the procedure. Shower with antiseptic wash the evening before and morning of the operation. Remove nail polish and jewellery. Bring your maternity notes and birth plan.
The Procedure
Step-by-step guide to what you can expect during your caesarean section procedure.
Pre-Operative Preparation and Consent
Pre-operative assessment confirms blood group FBC and clotting. The operation is explained in detail risks and benefits are discussed and written informed consent is obtained. Antacid medication is administered to reduce stomach acid risk.
Spinal Anaesthesia and Catheter Insertion
A spinal anaesthetic produces complete numbness from the chest downward within 5 to 10 minutes. A urinary catheter is inserted once the spinal is established. The mother is positioned with a left lateral tilt to prevent aortocaval compression.
Surgical Technique and Baby Delivery
A low transverse Pfannenstiel incision is made just above the pubic hairline. The uterus is opened and the baby delivered head-first. The baby is shown to the mother immediately and transferred for initial assessment and skin-to-skin contact.
Placental Delivery and Oxytocin Infusion
The placenta is delivered by controlled cord traction. An oxytocin infusion is started to contract the uterus and minimise blood loss. Prophylactic antibiotic is given at skin incision to reduce wound infection risk.
Uterine and Abdominal Closure
The uterus is closed in one or two layers with absorbable sutures. The abdominal fascia and subcutaneous tissue are closed in layers. The skin is closed with dissolvable subcuticular sutures.
Recovery and Early Post-Operative Care
The catheter remains in situ for 12 to 24 hours. Regular analgesics (paracetamol ibuprofen oral morphine) are prescribed. DVT prophylaxis with LMWH is prescribed from 6 hours post-operatively for all caesarean patients.
What to Expect
A spinal anaesthetic is administered. A urinary catheter is placed. You lie on the operating table with a screen at your chest level. Your birth companion sits beside your head. The operation proceeds behind the screen -- you feel pressure and movement but not pain. Your baby is lifted out, shown to you, and placed on your chest for skin-to-skin as soon as possible.
Recovery
You will have a urinary catheter for 12 to 24 hours after surgery. Pain is managed with regular paracetamol, ibuprofen, and oral morphine. Mobilise with assistance from 12 hours after surgery. Wound care: keep the wound clean and dry for 48 hours then shower normally. Contact maternity services or A&E for heavy bleeding, fever, wound opening, or severe pain.
Frequently Asked Questions
Common questions about caesarean section.
Related Services
Explore other services in our Obst & Gynec department.
Antenatal Care and Pregnancy Monitoring
Normal Labour and Delivery
Gynecological Ultrasound
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